Levemir to Tresiba?

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Hi all..so an update.

I'm finding the switch tough. I was on 23 units of levemir, split over 2 doses. My DN started me on 18 units of Tresiba but this has appeared to introduce me to night time hypos. I reduced the dose to 16 last week, but still having problems with sugar dropping between 9pm-1am. Hence why I am still awake at this hour. During the day, my sugars are averaging around 10 on this dose, so I am high during the day, and low at night. To be honest I'm pretty exhausted now. I never had an issue with rapid night time drops with levemir, and I'm also not liking the fact that its taking 2-3 days for any dose change with Tresiba to take effect. It's probably the worst time of year to be changing my basal insulin with xmas and being out of routine. But I'm struggling a bit. I am going to call my DSN in the morning but I'm not really sure they are in a position to decide if I can go back on levemir. Any advice would be greatly appreciated.
 
Have you basal tested since starting the Tresiba?
xx
 
Was your split on Levemir even, or did you take less at night?

suddenly getting early-hours drops certainly doesn’t seem ideal. Certainly worth asking your team about what to do next, what the switch was supposed to achieve and how long to leave it before switching back.
 
I took a unit or 2 less at night. I called my DSN and he has said to reduce the Tresiba to 14. He has said i could switch back to levemir if I wish but he doesn't want to do it until next week as they are closed a couple of days this week. I have tried to basal test but having to treat the low sugar at night, which is then keeping me high during the day. It's like I'm more insulin sensitive at night?
 
The Tresiba shouldn't be affected by sensitivity because it is quite a flat profile, have you considered changing your basal to morning? I know a few have had to change the timing of their basal to morning after switching to Tresiba and its made the world of difference so that's also worth considering xx
 
Lizzy78 said:
Hi all..so an update.

I'm finding the switch tough. I was on 23 units of levemir, split over 2 doses. My DN started me on 18 units of Tresiba but this has appeared to introduce me to night time hypos. I reduced the dose to 16 last week, but still having problems with sugar dropping between 9pm-1am. Hence why I am still awake at this hour. During the day, my sugars are averaging around 10 on this dose, so I am high during the day, and low at night. To be honest I'm pretty exhausted now. I never had an issue with rapid night time drops with levemir, and I'm also not liking the fact that its taking 2-3 days for any dose change with Tresiba to take effect. It's probably the worst time of year to be changing my basal insulin with xmas and being out of routine. But I'm struggling a bit. I am going to call my DSN in the morning but I'm not really sure they are in a position to decide if I can go back on levemir. Any advice would be greatly appreciated.
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Hi Lizzy,
Thanks for your latest....
I too found it very difficult (a tough time) getting the dose right, turns out I ended up on exactly the same dose as I was on on the lantus (20 units). I ended up going private because the local dsns and consultant just didn't know what they were doing in terms of Tresiba. btw I've always taken my basal in the morning. The biggest down side (which is also a plus side) is the delay in changing doses. It takes precisely 48hrs for a change in dose to take effect, so there wouldn't be a lot of point in changing any nearer than 3 days apart, Tresiba recommend 5 days (I think). So a change on Monday at 9am would start to come through on Wednesday at 9am. So Wednesday would be the day to check blood sugars over 24hrs. If anything can be learnt from that 24hrs, then potentially if needed, a change in dose could be started on the Thursday at 9am. This wouldn't then give any effect until Sat 9am. It's very frustrating waiting, cos in between you are really suffering with trying to balance blood sugars anyway possible.
I get drops sometimes, but only when I still have active bolus insulin running which can last up to 6hrs (Humalog). The Tresiba, for me at least is very reliable and very flat at all times of day, which can be clearly seen during basal tests.
 
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Amity Island said:
The Tresiba, for me at least is very reliable and very flat at all times of day, which can be clearly seen during basal tests.
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I think that would actually be a downside for me. Because having been on an insulin pump I’ve recognised that I need hardly any basal between midnight and about 3am - which probably explains all the years I had lows overnight on Lantus!
 
everydayupsanddowns said:
I think that would actually be a downside for me. Because having been on an insulin pump I’ve recognised that I need hardly any basal between midnight and about 3am - which probably explains all the years I had lows overnight on Lantus!
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Hi Mike,
I agree completely, not all insulins suit all people, it may be completely wrong in this instance and unworkable. I suppose you've got to try these thingso_O
 
Yeah I take the Tresiba in the morning, pretty much same time. For each dose I have tried it's the same pattern, running high during the day and dipping at night. My concern with the Tresiba aswell is the fact it's not as flexible as the Levemir. As it's been the festive period, I haven't been exercising as much. I paddleboard, wild swim and walk pretty much every day, and will be resuming this again soon. Looking ahead to the summer aswell, I also holiday in hot climates, and liked the flexibility to change my basal accordingly, rather than have to wait 3 days to see the reaction.
 
I am going to be on the reduced Tresiba dose until next Monday at least, so I will just need to see how that goes. But I think in my own head I have already made my mind up. I'll then have to go through the conversion back to levemir if that's what my team and I decide will be the best, so not sure how smoothly that will go. This has definitely not been the best of times since my DX last year. Feeling pretty exhausted with it all.
 
Lizzy78 said:
I am going to be on the reduced Tresiba dose until next Monday at least, so I will just need to see how that goes. But I think in my own head I have already made my mind up. I'll then have to go through the conversion back to levemir if that's what my team and I decide will be the best, so not sure how smoothly that will go. This has definitely not been the best of times since my DX last year. Feeling pretty exhausted with it all.
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Hi, sounds like you'll be moving back onto your previous insulin. I don't think the diabetes nurses have any real idea how exhausting it is when a basal isn't right. I'm interested in how they will advise going back to a 24hr insulin. Will it be started 48hrs after last dose of tresiba? Or is there a half life for tresiba and would a supplement of other basal insulin be required 24hrs after taking last dose of tresiba then onto full dose of basal 48hrs later. Good luck and I hope you start getting back to usual asap.
 
Amity Island said:
Hi, sounds like you'll be moving back onto your previous insulin. I don't think the diabetes nurses have any real idea how exhausting it is when a basal isn't right. I'm interested in how they will advise going back to a 24hr insulin. Will it be started 48hrs after last dose of tresiba? Or is there a half life for tresiba and would a supplement of other basal insulin be required 24hrs after taking last dose of tresiba then onto full dose of basal 48hrs later. Good luck and I hope you start getting back to usual asap.
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It's the nights that's have been exhausting me. I know that I might eventually find the right dose of the Tresiba, but I keep leaning towards the flexibility of levemir. I know it's probably just because I am used to the levemir aswell. I just need to sleep.

I'm not sure what the process would be if I switch back..obviously the Tresiba will be in my system for up to 3-4 days. It's going to tie in just at the time I am returning to work aswell. All fun and games.
 
If the lows are happening at night when you take your Tresiba in the morning couldn't you consider doing it in the evening? Then IF you do continue to go low at least you'll be awake and could snack at that time? xx
 
Kaylz said:
If the lows are happening at night when you take your Tresiba in the morning couldn't you consider doing it in the evening? Then IF you do continue to go low at least you'll be awake and could snack at that time? xx
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But if all the Tresiba daily doses last for 2-3 days, and overlap, there shouldn’t be any lows, caused by the Tresiba, I mean. My money's on Lizzy being like me, and her liver shutting up shop for the night, and only trickling out a fraction of what it does during the day.
 
I think no matter whether I took it in the A.M or P.M, the whole idea of Tresiba is to give a flatter profile through the day? As I say I am going to be on the lower dose again for the remainder of the week, will see how that goes. But I'm not sure I want to be on a basal where I am tied into a specific dose for at least 2-3 days. What about when I get back out paddleboarding/swimming? My choice would be to reduce dose 2-3 days in advance, or eat God only knows how much to keep levels up during activity?
 
Well its up to you, I find extra exercise is best dealt with by reducing following bolus doses but then I've only ever used Tresiba so its the only basal I know how to deal with xx
 
Lizzy78 said:
I think no matter whether I took it in the A.M or P.M, the whole idea of Tresiba is to give a flatter profile through the day? As I say I am going to be on the lower dose again for the remainder of the week, will see how that goes. But I'm not sure I want to be on a basal where I am tied into a specific dose for at least 2-3 days. What about when I get back out paddleboarding/swimming? My choice would be to reduce dose 2-3 days in advance, or eat God only knows how much to keep levels up during activity?
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The advice I was given by two diabetes consultants was Tresiba is for people with sedentary lifestyles, or at least those with little activity. On that basis alone, Tresiba isn't the best option for anyone wanting to take part in regular sport or fitness activities. That's not to say sport and fitness activities can't be done, but it requires eating extra carbs without boluses every 20mins or so, which isn't ideal if it's something being done regularly. Plus it requires about a 50% reduction in all boluses for up to 48 hrs after the session.
 
Lizzy78 said:
I think no matter whether I took it in the A.M or P.M, the whole idea of Tresiba is to give a flatter profile through the day? As I say I am going to be on the lower dose again for the remainder of the week, will see how that goes. But I'm not sure I want to be on a basal where I am tied into a specific dose for at least 2-3 days. What about when I get back out paddleboarding/swimming? My choice would be to reduce dose 2-3 days in advance, or eat God only knows how much to keep levels up during activity?
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I add. You will probably already know this but it is an important point. There is a threshold of activity which takes you into increased insulin sensitivity after the exercise. I got caught out once last year when I didn't think i'd gone over this level of exertion and not realised and ended up taking effectively double the bolus I needed (hence I should have taken 50% of usual dose). It was what I thought was a gentle cycle but I must of exerted myself more than I thought. For this reason, if I am going to do exercise, I make sure I do exert myself enough to ensure I know for sure that I will be on 50% bolus reductions after. Normal walking type exercise never increases my insulin sensitivity afterwards.
 
Lizzy78 said:
I think no matter whether I took it in the A.M or P.M, the whole idea of Tresiba is to give a flatter profile through the day? As I say I am going to be on the lower dose again for the remainder of the week, will see how that goes. But I'm not sure I want to be on a basal where I am tied into a specific dose for at least 2-3 days. What about when I get back out paddleboarding/swimming? My choice would be to reduce dose 2-3 days in advance, or eat God only knows how much to keep levels up during activity?
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Apologies if you have already answered this before, but if the basal insulin is causing issues on MDI, have you considered asking for a pump? I got very frustrated with MDI as I had a very varied week, like @everydayupsanddowns I had big dips overnight (and now know that I hardly need any insulin in the early hours) and was finding the variety of exercise I was doing very difficult to manage. Whilst it took quite a bit of work at the start, once I had my pump matched to my needs (which are set on an hourly basis) life became a lot easier. It also gives me the facility to turn down my background insulin which will react within an hour, and deliver the Bolus in a variety of ways to suit different foods.
 
Just catching up with this. I did try Tresiba last year, after lots of up and downs and enquiries on the forum. I have to admit I didn’t stay on it for that long as it just didn’t seem to suit me. To start with I was impressed seeing a much flatter line on my Libre, but I can be very active one day and not so the next, with no real pattern. So while some people can tweak with their bolus I personally found it just didn’t work for me...I just didn’t feel quite right on it. So I went back to playing around with split dose of Levemir. The DSNs were fine with this.

We are all so very different, with so many different things affecting our control...it’s just a matter of finding what we each feel happy and confident with. As others have said maybe it’s worth enquiring about a pump. I hope you find something that works for you soon.
 
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